Provider Demographics
NPI:1669832721
Name:EVIVE HEALTH LLC
Entity Type:Organization
Organization Name:EVIVE HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRASHANT
Authorized Official - Middle Name:
Authorized Official - Last Name:SRIVASTAVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-606-6394
Mailing Address - Street 1:600 W VAN BUREN ST
Mailing Address - Street 2:SUITE 603
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-3708
Mailing Address - Country:US
Mailing Address - Phone:312-374-9150
Mailing Address - Fax:
Practice Address - Street 1:600 W VAN BUREN ST
Practice Address - Street 2:SUITE 603
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-3708
Practice Address - Country:US
Practice Address - Phone:312-374-9150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management